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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200883
Report Date: 08/04/2022
Date Signed: 08/04/2022 03:56:23 PM

Document Has Been Signed on 08/04/2022 03:56 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:LA CALLE HAVENFACILITY NUMBER:
079200883
ADMINISTRATOR:LIPARDO, MELISSAFACILITY TYPE:
735
ADDRESS:1775 LA CALLETELEPHONE:
(925) 822-3610
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 6CENSUS: 5DATE:
08/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Bernadette Lee, AdministratorTIME COMPLETED:
04:08 PM
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On 8/4/2022 at 3:05 pm Licensing Program Analysts (LPAs) C. Fowler and L. Hall conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 07/14/2022. LPAs met with Bernadette Lee and explained the purpose of the visit.

Incident report stated S2 was helping a client to the bathroom and heard noises in the kitchen, C1 had gotten the key which was located in the cabinet over the stove and got his medication. C1 was popping the medication out of the bubble wrap into the kitchen sink. S2 immediately retrieved the key from C1, then secured the key to prevent C1 from getting into the other medications.

During LPAs interview with S1 it was stated that the staff has discussed the importance of securing the medications in a locked cabinet and the keys will be kept with the staff or in a secured location only accessible to staff.

No deficiencies issued during the visit.

Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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